RT Journal Article
SR Electronic
T1 Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e480
DO 10.1212/NXI.0000000000000480
VO 5
IS 5
A1 Kianush Karimian-Jazi
A1 Brigitte Wildemann
A1 Ricarda Diem
A1 Daniel Schwarz
A1 Thomas Hielscher
A1 Wolfgang Wick
A1 Martin Bendszus
A1 Michael O. Breckwoldt
YR 2018
UL http://nn.neurology.org/content/5/5/e480.abstract
AB Objective To assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable.Methods We included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years). MRI was performed at 3 Tesla with a standardized protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced sequences. Images were analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by 3 independent neuroradiologists. Isolated Gd-enhancing lesions without correlate in T2 and FLAIR images, and reactivated Gd+ lesions were further assessed for size and signal intensity.Results We identified a total of 343 new T2 lesions and 152 CE lesions in a total of 559 MRI follow-up examinations. New T2/FLAIR lesions were present in 30% of the scans. Of the Gd-enhancing lesions, 145/152 (95.4%) showed a correlate as a new T2/FLAIR lesion. There were 3 enhancing lesions (1.9% of all enhancing lesions) without T2/FLAIR correlate and 4 lesions (2.6%) that exhibited lesion reactivation or persistent enhancement over time. As a predictive factor of enhancement, we found that enhancing lesions had a higher T2 signal ratio (T2 SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ± 0.1, p < 0.001).Conclusion The likelihood of missing “active lesions” is overall small (1.7%) if T2 lesions are stable compared with the previous MRI examination. Lesion reactivation is rare. Our study indicates that Gd contrast administration might be dispensable in follow-up MRI of patients with MS if no new T2/FLAIR lesions and no new neurologic symptoms are present.BBB-D=blood-brain barrier disruption; CE=contrast enhancing; EDSS=Expanded Disability Status Scale; FLAIR=fluid-attenuated inversion recovery; GBCA=gadolinium-based contrast agent; NAWM=normal-appearing white matter